Author + information
- Received January 31, 2017
- Revision received May 7, 2017
- Accepted May 16, 2017
- Published online November 27, 2017.
- Shivank Madan, MD, MHAa,∗ (, )
- Snehal R. Patel, MDa,
- Peter Vlismas, MDb,
- Omar Saeed, MDa,
- Sandhya Murthy, MDa,
- Stephen Forest, MDc,
- William Jakobleff, MDc,
- Daniel Sims, MDa,
- Jacqueline M. Lamour, MDd,
- Daphne T. Hsu, MDd,
- Julia Shin, MDa,
- Daniel Goldstein, MDc and
- Ulrich P. Jorde, MDa
- aDivision of Cardiology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
- bDepartment of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
- cDepartment of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
- dDivision of Pediatric Cardiology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
- ↵∗Address for correspondence:
Dr. Shivank A. Madan, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, New York 10467.
Objectives This study sought to determine outcomes of adult recipients of early adolescent (EA) (10 to 14 years) donor hearts.
Background Despite a shortage of donor organs, EA donor hearts (not used for pediatric patients) are seldom used for adults because of theoretical concerns for lack of hormonal activation and changes in left ventricular mass. Nonetheless, the outcomes of adult transplantation using EA donor hearts are not clearly established.
Methods All adult (≥18 years of age) heart transplant recipients in the United Network for Organ Sharing database between April 1994 and September 2015 were eligible for this analysis. Recipients of EA donor hearts were compared with recipients of donor hearts from the usual adult age group (ages 18 to 55 years). Main outcomes were all-cause mortality and cardiac allograft vasculopathy up to 5 years, and primary graft failure up to 90 days post-transplant. Propensity score analysis was used to identify a cohort of recipients with similar baseline characteristics.
Results Of the 35,054 eligible adult recipients, 1,123 received hearts from EA donors and 33,931 from usual-age adult donors. With the use of propensity score matching, 944 recipients of EA donor hearts were matched to 944 recipients of usual-age adult donor hearts. There was no difference in 30-day, 1-year, 3-year, and 5-year recipient survival or primary graft failure rates in the 2 groups using both Cox hazards ratio and Kaplan-Meier analysis. Of note, adult patients who received EA donor hearts had a trend toward less cardiac allograft vasculopathy (Cox hazard ratio, 0.80; 95% confidence interval: 0.62 to 1.01; p = 0.07).
Conclusions In this largest analysis to date, we found strong evidence that EA donor hearts, not used for pediatric patients, can be safely transplanted in appropriate adult patients and have good outcomes. This finding should help increase the use of EA donor hearts.
This work was supported, in part, by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 31, 2017.
- Revision received May 7, 2017.
- Accepted May 16, 2017.
- 2017 American College of Cardiology Foundation